Medical irrigation device and method

ABSTRACT

An apparatus for supporting an extremity during tissue debridement and capturing fluid and tissue resulting from tissue debridement includes an extremity-supporting base. The apparatus may further include a barrier shroud. The apparatus can be used in tissue irrigation and debridement procedures to contain and control drainage of fluid and tissue. The apparatus supports a patient extremity, such as an arm or a leg. The base has a length, proximal end (i.e., nearest the patient&#39;s body), and distal end (i.e., farthest from the patient&#39;s body). The shroud can have a top portion, bottom portion, and shroud drainage opening. A method includes debriding tissue from a patient extremity supported by the base and at least partially enclosed within the barrier shroud, which acts as a shield for fluid and tissue emanating from the extremity. Fluid and tissue exit the shroud through a shroud drainage opening.

CROSS REFERENCE TO RELATED APPLICATIONS

This Application is a continuation of U.S. application Ser. No.13/766,063, which claims the benefit of U.S. Provisional Application No.61/633,464, filed Feb. 13, 2012, which are incorporated by reference intheir entirety.

BACKGROUND OF THE INVENTION 1. The Field of the Invention

The present invention relates to devices and methods for use in removingbiological debris from patient extremities. More specifically, thepresent invention relates to medical irrigation devices and methods forcontaining the fluid and solid biological debris ejected as a result ofdebridement using high-pressure jetted fluid.

2. Background and Relevant Art

Within the medical arts, it is common practice to remove infected and/ornecrotic tissues to allow for increased healing rates and to decreaseinfection risk. The clinical procedure for the above-mentioned action istermed wound debridement. A common component of the debridement processis copious fluid irrigation of the targeted tissue areas. The fluidsused are typically sterile saline but fluid with additionalantimicrobial agents may also be utilized.

In general, known techniques for tissue debridement include surgical,chemical, mechanical, and autolytic. Surgical debridement techniquesinclude conventional surgical techniques, involving the use of sharpmedical instruments, and hydrosurgical techniques, involving the use ofa high-pressure stream or spray of jetted fluid.

In hydrosurgical debridement, infected and/or necrotic tissue (i.e.,tissue that is dead, burned, diseased, infected, etc.), is ablated usinga stream or spray of water, saline, or other fluid directed under veryhigh pressure at the tissue to be removed. Because large amounts offluid are required, and because the high pressure of the fluid againstthe targeted necrotic tissue can result in uncontrolled emission offluid as well as the ablated pieces of infected and/or necrotic tissue,hydrosurgical debridement can be unsanitary and messy.

Uncontrolled tissue and fluid emission associated with hydrosurgicaldebridement can create problems for medical staff, such as contaminationof equipment, clothing, face shields or eye protection. In addition,hydrosurgical debridement procedures can require the complete turnoverand re-sterilization of some or all of equipment in the operating room,as well as a thorough disinfection and sterilization of every surface inthe operating room. Turnover, sterilization and disinfection proceduresare labor-intensive, time-consuming, and expensive.

As such, there exists a need for extremity supporting structures thatfacilitate the effective and convenient deployment of the irrigation anddebridement process.

SUMMARY

Disclosed herein are embodiments of apparatus for supporting anextremity during tissue debridement and capturing fluid and tissueresulting from tissue debridement and methods of debriding tissue of anextremity and capturing fluid and tissue resulting from tissuedebridement. The apparatus and methods can provide improved sanitaryconditions for a patient and medical personnel involved in a tissuedebridement procedure, as well as a cleaner environment in the operatingroom.

According to one embodiment, an apparatus for supporting an extremityduring tissue debridement and capturing fluid and tissue includes anextremity-supporting base configured to support an extremity of apatient during tissue debridement. The base can have a proximal endpositioned nearest a patient's body during use and a distal end oppositethe proximal end. A barrier shroud can be positionable so as to at leastpartially enclose an extremity placed on the extremity-supporting base.A drainage passageway can be provided that is in fluid communicationwith the extremity-supporting base and barrier shroud, which providescontrolled drainage of fluid and tissue from the extremity-supportingbase and barrier shroud during tissue debridement.

The extremity-supporting base may include a trough, such as a concavetrough, for cradling an extremity. The trough may have a trough bottomand a side wall on either side of the trough bottom. Theextremity-supporting base may be downwardly angled toward the drainagepassageway to facilitate movement of fluid and tissue toward thedrainage passageway during tissue debridement. According to oneembodiment, the drainage passageway is positioned at or near the distalend of the base to facilitate movement of fluid and tissue away from thepatient's body during tissue debridement. The drainage passageway can beprovided by a hole through the base and/or barrier shroud. A drainagetube may be attached to the drainage passageway to facilitate drainageof fluid and tissue into a receiving vessel. Drainage may begravitational or aspiration assisted.

According to one embodiment, the barrier shroud comprises a flexiblesheet material, such as a water-proof polymer. One or more braces thatcooperate with the flexible barrier shroud may advantageously maintainthe barrier shroud in a desired elevated configuration above theextremity-supporting base and relative to an extremity during tissuedebridement (e.g., to provide space between the shroud and extremity).The barrier shroud may include one or more fasteners that permitselective opening and closing of the barrier shroud relative to anextremity placed on the extremity-supporting base. The barrier shroudmay include an opening in an upper region that permits access to theextremity by a debridement instrument, such as a high-pressureirrigation device.

According to one embodiment, the extremity-supporting base may be formedfrom an open-cell foam material (e.g., flexible polyurethane foam). Aflexible, fluid-impermeable coating may be positioned over at least aportion of the open-cell foam material to provide additional sterilityand ease of cleaning.

According to another embodiment, a method of debriding tissue of anextremity and capturing fluid and tissue resulting from tissuedebridement includes: (1) placing an extremity of a patient on anextremity-supporting base; (2) at least partially enclosing saidextremity with a barrier shroud; and (3) debriding a portion of saidextremity using a high-pressure fluid, (4) the base and barrier shroudsubstantially containing fluid and tissue resulting from tissuedebridement and controlling drainage of said fluid and tissue. Themethod may include gravitational and/or aspiration assisted drainage offluid and tissue through a drainage hose in fluid communication with thebarrier shroud and base.

This Summary is provided to introduce in a simplified form a selectionof concepts that are further described below in the DetailedDescription. This Summary is not intended to identify key or essentialfeatures of the claimed subject matter, nor is it intended to be used asan aid in determining the scope of the claimed subject matter.Additional features and advantages of the invention will be set forth inthe description which follows, and in part will be evident to persons ofordinary skill in the art from the description and appended claims, ormay be learned by such persons through the practice of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

In order to describe the manner in which the above-recited and otheradvantages and features of the invention can be obtained, a moreparticular description of the invention briefly described above will berendered by reference to specific embodiments thereof which areillustrated in the appended drawings. It should be noted that thefigures are not necessarily drawn to scale, and that elements of similarstructure or function are generally represented by like referencenumerals for illustrative purposes throughout the figures. Thesedrawings depict only certain embodiments of the invention and are nottherefore to be considered to be limiting of its scope.

FIG. 1 is an example embodiment of an extremity-supporting base having adownward sloping concave trough with a dam and drainage opening at adistal end.

FIG. 1A is a transverse cross-sectional view of FIG. 1.

FIG. 2 is an alternative embodiment of an extremity-supporting basehaving a downward sloping concave trough and being open at a distal end.

FIG. 2A is a transverse cross-sectional view of FIG. 2.

FIG. 3 illustrates an example embodiment of an apparatus for supportingan extremity during tissue debridement and capturing fluid and tissue,which includes a base supporting an extremity (i.e., leg) and a flexiblebarrier shroud partially enclosing the extremity.

FIG. 4 illustrates another embodiment of an apparatus for supporting anextremity during tissue debridement and capturing fluid and tissue,which includes an extremity-supporting base and a flexible barriershroud with fasteners that permit selective fastening and unfastening ofthe shroud during placement and removal of an extremity on the base.

FIG. 5 illustrates the embodiment of FIG. 4 supporting an extremityduring tissue debridement and capturing fluid and tissue attached to adrainage tube and a patient extremity ready to undergo tissuedebridement.

FIG. 6 is an alternative view of the embodiment illustrated in FIG. 5.

FIG. 7 illustrates the apparatus of FIG. 6 for supporting an extremityduring tissue debridement and capturing fluid and tissue attached to adrainage tube in which the shroud includes an opening in an upperportion to facilitate access by a debridement instrument to the patientextremity.

DETAILED DESCRIPTION

The following are example embodiments of apparatus for supporting anextremity during tissue debridement and capturing fluid and tissueresulting from tissue debridement and methods of debriding tissue of anextremity and capturing fluid and tissue resulting from tissuedebridement. According to one embodiment, an extremity supportingmedical irrigation ramp (or apparatus for supporting an extremity duringtissue debridement and capturing fluid and tissue resulting from tissuedebridement) is composed of two elements: an extremity-supporting,fluid-channeling element (or extremity-supporting base) and a sterile,barrier element (or barrier shroud). In one embodiment, theextremity-supporting base may be constructed from open cell foammaterial at least partially covered with a fluid impermeable, flexibleexterior coating. The exterior coating is may comprise a polymeric,non-latex composition.

The extremity-supporting base may include a concave surface thatsupports the patient's extremity (e.g., arm or leg). The concavity ofthe extremity-supporting element can function to channel fluids appliedduring the debridement procedure and also tissue removed duringdebridement toward a distal end of the device. The extremity-supportingbase may further include a downward slope, which slopes downward towarda distal end of the extremity-supporting base. In one embodiment, a damfeature at a distal end of the apparatus allows for pooling of appliedfluids and removed tissues. A drainage hole at or near the distal endallows for the continuous removal/evacuation of fluids and tissue. Thedam might form part of the extremity-supporting base and/or it may bepart of the barrier shroud.

For each individual debridement case (i.e., each new patient extremity),a new sterile, barrier element or shroud may be used by placing itbetween the patient's extremity and the extremity-supporting base. Inthis way, the extremity-supporting base can be kept sterile and re-usedif desirable, while the barrier shroud is a single-use, disposablefeature. Alternatively, the base may itself be disposable. The barriershroud can be a smooth plastic sheet that easily conforms to the concaveshape of the extremity-supporting base and is advantageously of adequatesize to cover all potential patient extremity-contacting surfaces of theextremity-supporting base.

According to one embodiment, the barrier element may include a drainagehole and an integrated, semi-rigid drainage tube that is of a diameterto slide into a drainage hole at the distal extent of theextremity-supporting base (when included). The drainage tube can be ofsufficient length to extend significantly beyond the bottom surface ofthe extremity-supporting base, when fully engaged. Alternatively, adrainage tube can be attached to the drainage hole of the barrierelement when positioned beyond a distal end of the extremity-supportingelement. The drainage tube allows for fluids applied during thedebridement procedure to exit the device via gravity-assisted, fluidmovement into a receiving vessel or, alternatively, via suction assistedevacuation of fluids.

To further capture fluid droplets that may possess an upwards trajectoryduring the debridement procedure, the sterile covering element or shroudmay comprise a “greenhouse” structure (e.g., by means of hoops or bracesthat hold the barrier shroud in a desired configuration during use).This feature can attach at the lateral edge of the device and arch overthe extremity. The “greenhouse” structure can be made from clear plasticto allow for adequate visualization of the debridement field. Right andleft side slits may run along the length of the “greenhouse” structureso as to allow for insertion of a tip of an irrigation device throughthe plastic barrier and direct access to the debridement site.

The top portion of the barrier shroud may include an opening formedtherein to allow a hydrosurgical debridement device to access thedebridement site of the extremity. The top portion and bottom portionmay be joined together around the edges in either a permanent manner orin a manner designed to allow the shroud to be opened and closed (e.g.,like a sleeping bag). The top portion and bottom portion of the shroudmay include fasteners such as snaps, Velcro® (hook and loop), zippers,hooks, clasps, or other fastening elements known in the art which canallow the shroud to be selectively opened and closed.

Referring now to FIG. 1, an embodiment of an extremity-supporting base10 is shown. Base 10 has a proximal end 11 and a distal end 12 defininga length 13 between proximal end 11 and distal end 12. Proximal end 11is typically positioned nearest to the patient's body (e.g., torso inthe case of a leg or shoulder in the case of an arm). Distal end 12 istypically the end farthest away from the patient's body.

Base 10 is configured for use as a support for a patient extremity, suchas an arm or a leg, which can be further enclosed within a shroud,discussed below, during the process of hydrosurgical wound debridement.According to one embodiment, base 10 can have a concave support surfaceto help cradle and hold a patient extremity in a desired orientation,and which can direct fluid and tissue debris associated withhydrosurgical debridement toward the lowest point of a downwardlysloping support surface. Base 10 may therefore be constructed such thata trough 14 having a concave shape extends along part or all of thelength 13 of base 10. Trough 14 as illustrated includes a trough bottom15 that also runs along part or all of the length 13 of base 10. Trough14 and trough bottom 15 are more particular illustrated in FIG. 1A,which is a cross-sectional view of base 10 as seen from proximal end 11.

To control runoff of fluid and tissue debris associated with adebridement procedure, trough 14 can be sloped downward along the baselength 13 from a high point 16 at proximal end 11 to low point 17 atdistal end 12. In the illustrated embodiment, positioned at or near thelow point 17 is a base drainage opening or passageway 18. A base dam 19is positioned at distal end 12 in close proximity to base drainageopening 18 such that excess fluid and tissue debris associated withdebridement can build-up in the area adjacent to base drainage opening18, which facilitates controlled drainage of such fluid and tissuedebris through passageway or hole 18. Drainage can be by gravity aloneor assisted by applied vacuum suction.

In an alternative embodiment (not shown), the trough bottom may includemore than one high point and either side of a low point. The multiplehigh points and trough bottom low point may be arranged such that atrough bottom low point is located at or near the center of the base topromote drainage through a passageway at this location. Alternatively,the trough bottom may include a high point in the center and low pointsat the proximal and distal ends.

Base 10 may be made of open-cell foam and may have a coating thereofthat is fluid-impermeable and flexible. The coating on base 10 may beformed of a polymeric, non-latex composition.

Referring now to FIG. 2, another embodiment of an extremity-supportingbase 20 is illustrated. Some features of base 20 are the same as thoseof base 10. However, extremity-supporting base 20 lacks a base dam 19adjacent to a base drainage opening 18 as shown in FIG. 1. Base 20includes a proximal end 21, a distal end 22, a length 23, a trough 24, atrough bottom 25 (shown in FIG. 2A, which is a cross-sectional view ofbase 20 viewed from distal end 22), a trough bottom high point 26, and atrough bottom low point 27. Thus, trough 24 generally slopes downwardlytoward distal end 22 (i.e., the extremity-supporting base 20 has aheight that decreases from trough bottom high point 26 to trough bottomlow point 27 and therefore slopes downwardly to facilitate drainagetoward distal end 22. FIG. 2 also depicts trough 24 as having a lengththat is less than overall length 23 because of a downwardly slopingproximal surface extending from trough bottom high point 26 towardproximal end 21. Base 20 further includes a curved cut-out portionbetween proximal end 21 and the proximal surface.

Extremity-supporting base 20 is depicted as being open at the proximalend 21 and open at the distal end 22 to enable fluid to move distallyalong the trough 24 toward and beyond the distal end 22 of the trough24. Base 20 also provides a continuous support surface of fixed lengththat is downwardly sloped at a constant angle of decline along anentirety of the trough 24. Trough 24 is illustrated as sloping downwardfrom the high point 26 to the low point 27 at a constant angle ofdecline. As illustrated, trough 24 includes two opposing sidewalls whatcan be parallel to each other.

Like base 10, base 20 is designed for use as a support for a patientextremity, such as an arm or a leg, during the process of tissuedebridement. Because base 20 does not have a base dam or a base drainageopening, an embodiment of a barrier shroud (discussed below) thatcooperates with base 20 may be different than the shroud embodimentdesigned to cooperate with base 10. Specifically, the shroud drainageopening does not align with a base drainage opening when using base 20because base 20 has no base drainage opening. In one embodiment, base 20may be used with and support a barrier shroud having a shroud dam and ashroud drainage opening that are positioned beyond distal end 22 of base20, as will be discussed in more detail below.

Like base 10, base 20 may be made of open-cell foam and may have acoating that is fluid-impermeable and flexible. The coating on base 20may be formed of a polymeric, non-latex composition.

Although not depicted in the drawings, base 10 may operate together witha shroud that has a shroud drainage opening and a drainage hose thatcooperate with base drainage opening 18 of base 10 such that the shroudincludes a drainage opening which substantially lines up over basedrainage opening 18 and a drainage hose that fits down and through basedrainage opening 18 and extends beyond an underside of base 10.

FIG. 3 illustrates an extremity-supporting base similar to base 20 incooperation with an embodiment of a barrier shroud 200. This embodimentof shroud 200 as shown has a top portion 201, a bottom portion 202, anda shroud drainage opening 203. A shroud dam 204 is formed by a raised orvertical portion just beyond shroud drainage opening 203 interconnectingtop portion 201 and bottom portion 202. Shroud drainage opening 203 isattached to a drainage hose 205 that extends down and leads away fromshroud 200. Shroud dam 204 is positioned beyond and below a distal endof the base in close proximity to shroud drainage opening 203 such thatthe excess fluid and tissue debris associated with tissue debridementmay pool in an area of shroud 200 beyond and below the distal end of thebase. Fluid and tissue may exit shroud drainage opening 203 with the aidof gravity and/or applied vacuum suction.

The availability of vacuum suction may alternatively permit shrouddrainage opening 203 to be alternatively located in other regions of theshroud 200, such as in dam 24 or even top portion 201 of shroud 200 iftop and bottom portions 201, 202 of shroud 200 are sealed at all pointsexcept the opening adjacent to the proximal end of the base.

One purpose of barrier shroud 200 is to contain fluid and removed tissuethat may tend to spatter or be emitted from patient extremity 206 duringthe debridement process. Consistent with this purpose, the material forshroud 200 is advantageously fluid-impermeable or fluid-resistant.However, since shroud 200 is intended only for a single use and need notendure repeated exposure to fluid, materials that are not strictlyfluid-resistant or fluid-impermeable may suffice.

In use, shroud 200 is positioned over patient extremity 206 such thatbottom portion 202 of shroud 200 lies beneath extremity 206 but abovethe base, which supports the shroud-encased patient extremity 206. Topportion 201 of shroud 200 further includes one or a plurality of braces207 operatively associated with top portion 201, although two braces 207are shown in this illustrated embodiment. One purpose of brace 207 is tosuspend top portion 201 over patient extremity 206 such that top portion201 does not come into substantial contact with patient extremity 206.Another purpose of brace 207 is to provide the surgeon and medical staffwith sufficient working space above patient extremity 206 but below topportion 201 so as to allow for the effective carrying out of ahydrosurgical debridement procedure.

The material used for brace 207 and the mechanism for operativelyrelating brace 207 with top portion 201 may be selected from any of anumber of materials and methods consistent with accomplishing thesepurposes. Brace 207 may be operatively associated with top portion 201in any of a number of conventional ways, including, but not limited to,being slidably positioned in a slot formed in top portion 201, fixedlyattached to top portion 201 with adhesive, or integrally formed into thematerial of top portion 201 during manufacture. Brace 207 may be offixed shape, such as the arcuate shape illustrated in FIG. 3, or may beof a deformable material, such as a soft metal, that can be manipulatedinto a desired shape.

Shroud 200 of FIG. 3 may be formed in a manner similar to that shown inFIG. 4 such that top portion 201 opens like a flap, or the top part of asleeping bag, wherein top portion 201 is permanently joined to bottomportion 202 along one edge of shroud 200 (adjacent the length 23 of thebase 20) and is attachable to bottom portion 202 along the opposite edgeusing known fastening devices such as snaps, Velcro® (hook and loop),buttons, clasps, hooks or zippers.

Top portion 201 and bottom portion 202 of shroud 200 may be joined inthe manner shown in FIG. 3, that is, permanently joined along bothopposing side edges and may or may not be permanently joined along thebottom edge, adjacent distal end of the base 20.

Shroud 200 may also include one or more slit openings, such as theopening 229 shown in FIG. 7, formed in top portion 201 so as to allowaccess to patient extremity 206 by a debridement instrument during adebridement procedure.

Referring now to FIG. 4, another embodiment of an illustrative shroud220 is shown. The features of shroud 220 are similar to those of shroud200 shown in FIG. 3, with three primary exceptions: shroud 220 has nobrace 207; shroud 220 is open at both ends, not just at the endassociated with the proximal end of the base; and shroud 220 has aseparate shroud wall or dam 224 formed into or attached to a bottomportion 222 and does not, as is illustrated in FIG. 3, rely upon theregion where the top and bottom portions meet to function as the shrouddam. Otherwise, shroud 220 has a top portion 221, a bottom portion 222,a shroud drainage opening 223, a shroud wall or dam 224 distal of saiddrainage opening 223, and a drainage hose 225.

Shroud dam 224 can be a ridge-like structure formed into bottom portion222 of shroud 220 and may be positioned beyond and below the distal endof the base in close proximity to shroud drainage opening 223 such thatfluid and tissue debris associated with debridement may pool in the areanear shroud drainage opening 223 and exit shroud drainage opening 223with the aid of either gravity or applied vacuum suction. Alternatively,shroud dam 224 may be a separately formed structure that is fixedlyattached to shroud bottom 222 using known methods, such as heat to theshroud dam 224 to shroud bottom portion 222, or glue, or otheradhesives.

As can be seen in FIG. 4, top portion 221 can open and close like aflap, and shroud 220 is open at both ends adjacent the proximal anddistal ends of the base. Top portion 221 is permanently joined to bottomportion 222 along one edge of shroud 220 and is releasably attachable tobottom portion 222 along the opposite edge using known fastening devices228 such as snaps, Velcro®, buttons, hooks, clasps or zippers. Asillustrated in FIGS. 4-7, shroud 220 can fully enclose theextremity-supporting base, including the entire bottom surface of theextremity supporting base.

FIGS. 5-7 show the embodiment of FIG. 4 in use, where the base andshroud 220 cooperate to support and enclose a patient extremity 226.FIG. 5 illustrates an aspiration device 250 for applying suction todrainage hose 225. FIG. 6 shows the same configuration of base 20 andshroud 220 but viewed from the distal end 22 of the base 20 towards theproximal end 21 of the base 20. FIG. 7 is the same as FIG. 6 butillustrates the incorporation of at least one opening 229, in the formof a slit in the embodiment shown, in top portion 221 of shroud 220 soas to allow access to patient extremity 226 by the debridementinstrument being operated by the medical personnel.

The present invention may be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. The describedembodiments are to be considered in all respects only as illustrativeand not restrictive. The scope of the invention is, therefore, indicatedby the appended claims rather than by the foregoing description. Allchanges which come within the meaning and range of equivalency of theclaims are to be embraced within their scope.

1. An apparatus for supporting an extremity and capturing fluid andtissue resulting from tissue irrigation and debridement, comprising: anextremity-supporting base configured to support an extremity of apatient during tissue irrigation and debridement, theextremity-supporting base having: a proximal end positioned nearest apatient's body during use; a distal end opposite the proximal end; abottom surface; a support surface; and a total of two opposing sidewallsextending above the support surface and longitudinally along sides ofthe support surface; the support surface and the two opposing sidewallsforming a trough of fixed length longitudinally extending from a firstpoint near the proximal end of the extremity-supporting base to a secondpoint near the distal end of the extremity-supporting base and beingadapted for placement and support of an extremity thereon, theextremity-supporting base having a height that decreases from the firstpoint to the second point so that the trough slopes downwardly betweenthe first point and the second point, the extremity-supporting basebeing open at the proximal end and open at the distal end to enablefluid to move distally along the trough toward and beyond a distal endof the trough.
 2. The apparatus of claim 1, the downwardly sloped troughproviding a continuous support surface of fixed length that isdownwardly angled at a constant angle of decline along an entirety ofthe trough to facilitate movement of fluid and tissue toward the distalend of the trough during tissue irrigation and debridement.
 3. Theapparatus of claim 1, wherein the two opposing sidewalls are parallel toeach other.
 4. The apparatus of claim 1, the extremity-supporting basefurther including a sloped proximal surface that slopes downwardly fromthe first point toward the proximal end.
 5. The apparatus of claim 4,the extremity-supporting base further including a curved cut-out portionbetween the proximal end of the base and the sloped proximal surface. 6.The apparatus of claim 1, further comprising a barrier shroud adapted toat least partially cover an extremity on the support surface of theextremity-supporting base.
 7. The apparatus of claim 6, wherein thebarrier shroud is adapted to fully enclose the extremity-supporting baseincluding the bottom surface.
 8. The apparatus of claim 6, the barriershroud including a drainage opening positioned to receive fluid passingdistally beyond the distal end of the trough.
 9. The apparatus of claim8, the barrier shroud including a wall or dam distal of the drainageopening and a drainage tube in fluid communication with the drainageopening.
 10. The apparatus of claim 6, the barrier shroud comprising aflexible sheet material.
 11. The apparatus of claim 1, theextremity-supporting base comprising an open-cell foam material.
 12. Theapparatus of claim 11, the extremity-supporting base further comprisinga flexible fluid-impermeable coating on said open-cell foam material.13. An apparatus for supporting an extremity and capturing fluid andtissue resulting from tissue irrigation and debridement, comprising: anextremity-supporting base configured to support an extremity of apatient during tissue irrigation and debridement, theextremity-supporting base having: a proximal end positioned nearest apatient's body during use; and a distal end opposite the proximal end,the extremity-supporting base forming a trough of fixed length extendingfrom a high point near the proximal end to a low point near the distalend and configured to provide a support surface for an extremity, thetrough sloping downwardly from the high point to the low point at aconstant angle of decline.
 14. The apparatus of claim 13, wherein theextremity-supporting base comprises an open-cell foam material.
 15. Theapparatus of claim 13, further comprising a barrier shroud that at leastpartially covers an extremity on the support surface of theextremity-supporting base.
 16. The apparatus of claim 15, the barriershroud further comprising a drainage hole through which fluid and tissuecan drain during tissue irrigation and debridement.
 17. An apparatus forsupporting an extremity during tissue debridement and capturing fluidand tissue resulting from tissue debridement, comprising: anextremity-supporting base configured and adapted to support an extremityof a patient during tissue debridement, the extremity-supporting basehaving: a proximal end positioned nearest a patient's body during use, adistal end opposite the proximal end, a bottom surface, and a troughforming a support surface of fixed length; a barrier shroud positionableand adapted to fully enclose the extremity-supporting base, includingthe entire bottom surface, and adapted to at least partially enclose anextremity supported by the support surface of the extremity-supportingbase; and a drainage passageway at or near a distal end of the barriershroud that provides drainage of fluid and tissue during tissueirrigation and debridement.
 18. The apparatus of claim 17, theextremity-supporting base comprising an open-cell foam material.
 19. Theapparatus of claim 17, wherein the distal end of theextremity-supporting base is open to enable fluid to move distally alongthe trough toward and beyond a distal end of the trough.
 20. Theapparatus of claim 19, wherein the drainage passageway is disposeddistal of the distal end of the trough.